Are school-based physical activity interventions effective and equitable? A systematic review and meta-analysis of cluster randomised controlled trials

Background

Childhood obesity is increasing globally, with widening inequalities by socioeconomic status and sex. The aim of this study was to assess the efficacy of school-based physical activity interventions on children's daily moderate-to-vigorous physical activity (MVPA), and variations in efficacy by sex and socioeconomic status.

Can stand‐alone computer‐based interventions reduce alcohol consumption? A systematic review

Aim To determine the effects of computer‐based interventions aimed at reducing alcohol consumption in adult populations. Methods The review was undertaken following standard Cochrane and Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidance for systematic reviews. The literature was searched until December 2008, with no restrictions on language. Randomized trials with parallel comparator groups were identified in the form of published and unpublished data. Two authors independently screened abstracts and papers for inclusion. Data extraction and bias assessment was undertaken by one author and checked by a second author. Studies that measured total alcohol consumption and frequency of binge drinking episodes were eligible for inclusion in meta‐analyses. A random‐effects model was used to pool mean differences. Results Twenty‐four studies were included in the review (19 combined in meta‐analyses). The meta‐analyses suggested that computer‐based interventions were more effective than minimally active comparator groups (e.g. assessment‐only) at reducing alcohol consumed per week in student and non‐student populations. However, most studies used the mean to summarize skewed data, which could be misleading in small samples. A sensitivity analysis of those studies that used suitable measures of central tendency found that there was no difference between intervention and minimally active comparator groups in alcohol consumed per week by students. Few studies investigated non‐student populations or compared interventions with active comparator groups. Conclusion Computer‐based interventions may reduce alcohol consumption compared with assessment‐only; the conclusion remains tentative because of methodological weaknesses in the studies. Future research should consider that the distribution of alcohol consumption data is likely to be skewed and that appropriate measures of central tendency are reported.     

Does music reduce anxiety and discomfort during flexible sigmoidoscopy?A systematic review and meta-analysis

AIM To investigate the role of music in reducing anxiety and discomfort during flexible sigmoidoscopy. METHODS A systematic review of all comparative studies up to November 2016, without language restriction that were identified from MEDLINE and the Cochrane Controlled Trials Register(1960-2016), and EMBASE(1991-2016). Further searches were performed using the bibliographies of articles and abstracts from major conferences such as the ESCP, NCRI, ASGBI and ASCRS. Me SH and text word terms used included sigmoidoscopy, music and endoscopy and anxiety. All comparative studies reporting on the effect of music on anxiety or pain during flexible sigmoidoscopy, in adults, were included. Outcome data was extracted by 2 authors independently using outcome measures defined a priori. Quality assessment was performed.RESULTS A total of 4 articles published between 1994 and 2010, fulfilled the selection criteria. Data were extracted and analysed using OpenM etaA nalyst. Patients who listened to music during their flexible sigmoidoscopy had less anxiety compared to control groups [Random effects; SMD: 0.851(0.467, 1.235), S.E = 0.196, P 0.001]. There was no statistically significant heterogeneity(Q = 0.085, df = 1, P = 0.77, I2 = 0). Patients who listened to music during their flexible sigmoidoscopy had less pain compared to those who did not, but this difference did not reach statistical significance [Randomeffects; SMD: 0.345(-0.014, 0.705), S.E = 0.183, P = 0.06]. Patients who listened to music during their flexible sigmoidoscopy felt it was a useful intervention, compared to those who did not(P 0.001). There was no statistically significant heterogeneity(P = 0.528, I2 = 0). CONCLUSION Music appeared to benefit patients undergoing flexible sigmoidoscopies in relation to anxiety and was deemed a helpful intervention. Pain may also be reduced however further investigation is required to ascertain this.     

Are couple-based interventions more effective than interventions delivered to individuals in promoting HIV protective behaviors? A meta-analysis

Despite several advantages to bringing couples together to learn how to protect themselves and new-born children from the risk of HIV infection, most interventions are designed for individuals or groups, not for dyads. This meta-analysis provides a direct test of whether couple-based interventions are more effective in promoting HIV protective behaviors than interventions delivered to individuals. We conducted systematic searches of five electronic databases and 60 journals. Eligible studies were controlled trials or prospective cohort designs; evaluated a couple-based intervention compared to an individual-level intervention; assessed at least one HIV prevention outcome (e.g., protective sex, drug use, HIV testing, medication adherence, and sexually transmitted infections [STI]); and were published between 1988 and 2014. Fifteen interventions, including 21,882 participants from China, Kenya, Rwanda, Tanzania, Trinidad, Zambia, and the USA, were evaluated. The results of random-effects models showed statistically significant intervention effects for protective sex (OR = 1.60, 95% CI = 1.21, 2.11), HIV testing (OR = 1.79, 95% CI = 1.31, 2.45), and Nevirapine uptake (OR = 1.51, 95% CI = 1.02, 2.24). The evidence demonstrates the usefulness of couple-based interventions in protecting individuals, partners, and new-born children from the risk of HIV transmission and infection.     

Maternal anti-tumour necrosis factor-α drug use during pregnancy and risk of infection in the offspring: A systematic review and meta-analysis

BackgroundAnti-tumour necrosis factor (TNF)-α drugs are used by increasing numbers of reproductive-age women. Although the neonatal outcomes have been described, there are concerns regarding the risk of infection in offspring following exposure to anti-TNF-α.MethodsA literature search was conducted using Pubmed, EMBASE, and the Cochrane Database, from inception through August 2020. We evaluated the risk of infection in autoimmune disease (AID) offspring unexposed to anti-TNF-α compared to AID offspring exposed to anti-TNF-α, as well as to unexposed non-AID offspring.ResultsOur primary analysis showed that both AID offspring unexposed to anti-TNF-α [risk ratio (RR) 1.09; 95% confidence interval (CI), 1.03–1.16; I²=0%] and AID offspring exposed to anti-TNF-α (RR 1.39; 95% CI, 1.2–1.61; I²=0%] was associated with an increased risk of infection during the first year of life compared with the unexposed non-AID offspring. However, our secondary analysis demonstrated that AID offspring exposed to anti-TNF-α was not associated with an increased risk of infection when compared with AID offspring unexposed to anti-TNF-α (RR=1.1; 95% CI, 0.86–1.4).ConclusionOur results suggest that in utero exposure to anti-TNF-α does not appear to increase the risk of infection during the first year of life in the offspring; however, AID itself was associated with a marked excess risk of infection in the children.     

Are dual-chamber implantable cardioverter-defibrillators really better than single-chamber ones? A systematic review and meta-analysis

Purpose

Although dual-chamber (DC) cardioverter defibrillators (ICDs) offer theoretical advantage over single-chamber (SC) ICDs, clinical studies showed conflicting results. The aim of this systematic review and meta-analysis was to compare DC and SC ICDs.

Methods

A systematic search of publications in PubMed, Embase, and the Cochrane Library without language restriction was performed. Randomized or nonrandomized controlled studies that compared DC and SC ICDs were included.

Results

Six randomized studies including 2,388 patients and 14 nonrandomized studies including 113,931 patients were identified. No difference in mortality was observed between DC and SC ICDs recipients in randomized studies. In nonrandomized studies, higher mortality was shown in DC group. There was no difference in the rate of inappropriate therapy between the DC and SC group after pooling the results from randomized studies as well as nonrandomized studies. More complications were observed with DC ICDs recipients.

Conclusions

DC ICDs showed no conclusive superiority over SC ICDs. Without indications for antibradycardia therapy, SC ICDs seem to be the preferred selection.     

Vitamin D in psoriatic arthritis – A systematic review and meta-analysis

BackgroundThis systematic review and meta-analysis aimed to summarize current evidence on vitamin D status in patients with psoriatic arthritis (PsA) with a particular focus on disease activity.MethodsPubMed, Web of Science, Scopus and Cochrane Library databases were searched for studies that investigated vitamin D levels in PsA. The search was conducted on 12^th October 2022. Included studies were cohorts, RCTs or observational studies, those assessing the level of 25(OH)D₃ with control group consisting of healthy or psoriasis (Pso) patients. Nottingham-Ottawa Quality Scale was used to assess methodological quality. Random effects meta-analysis model was applied with inverse variance weighting and mean difference with 95% CI was calculated.ResultsOf 356 retrieved studies, 76 duplicates and 270 studies were excluded according to the exclusion criteria with one study unavailable. Four studies including 264 PsA patients and 287 healthy controls and five studies including 225 PsA patients and 391 Pso patients assessing vitamin D levels were eligible for meta-analysis. Vitamin D levels were lower in PsA patients compared to the healthy group (MD = -6.42; 95 % CI -8.31, -4.53; P < 0.01), while higher compared to Pso patients (MD = 2.37; 95 % CI 0.97, 3.78; P < 0.01). Included studies had moderate to low risk of bias.ConclusionIn conclusion, PsA patients have lower vitamin D levels than the general population. However, further studies are essential to understand the role of vitamin D in the development and treatment of PsA and the differences in vitamin D metabolism in PsA and Pso.     

Are primary/elementary school‐based interventions effective in preventing/ameliorating excess weight gain? A systematic review of systematic reviews

This systematic review of systematic reviews addresses a current gap in evidence by synthesizing findings relating to weight management interventions set entirely in primary/elementary schools targeting, diet, and/or physical activity as key strategies. Eight databases were searched for systematic reviews of trials of school‐based interventions targeting children aged 4 to 12 years that looked at biometric and behavioral outcomes. From the 10 selected systematic reviews, we found that interventions designed to promote physical activity or reduce sedentary behavior were most effective for weight loss. Interventions designed to improve diet and nutrition had a small effect on behavioral and cognitive outcomes, and these outcomes could be enhanced through the use of experiential learning. The most effective interventions involved a range of stakeholders in the development process and included parents and families in implementation. This systematic review of systematic reviews offers evidence‐based guidance for the development and implementation of multistrategy weight‐management interventions in primary/elementary schools.     

Is the intraoperative air leak test effective in the prevention of colorectal anastomotic leakage? A systematic review and meta-analysis

Objective

The intra-operative air leak test (ALT) is a common intraoperative test used to identify mechanically insufficient anastomosis. This meta-analysis aims to determine whether ALT aids to the reduction of postoperative colorectal anastomotic leakage (CAL).

Methods

A literature search was performed to select studies in acknowledged databases. Full text articles targeting ALT during colorectal surgery were included. Quality assessment, risk of bias, and the level-of-evidence of the inclusions were evaluated. ALT methodology, ALT(+) (i.e., leak observed during the test) rate, and postoperative CAL rate of the included studies were subsequently analyzed.

Results

Twenty studies were included for analysis, in which we found substantial risks of bias. A lower CAL rate was observed in patients who underwent ALT than those did not; however, the difference was not significant (p = 0.15). The intraoperative ALT(+) rate greatly varied among the included studies from 1.5 to 24.7 %. ALT(+) patients possessed a significantly higher CAL rate than the ALT(?) patients (11.4 vs. 4.2 %, p < 0.001).

Conclusions

Based on the available evidence, performing an ALT with the reported methodology has not significantly reduced the clinical CAL rate but remains necessary due to a higher risk of CAL in ALT(+) cases. Unfortunately, additional repairs under current methods may not effectively decrease this risk. Results of this review urge a standardization of ALT methodology and effective methods to repair ALT(+) anastomoses.

     

Device assisted enteroscopy in the elderly — A systematic review and meta-analysis

BackgroundDevice assisted enteroscopy (DAE) is increasingly being carried out in elderly patients. This provides a challenge due to the underlying varied physiology and comorbidities these patients have.MethodsWe performed a systematic literature search for studies on elderly patients undergoing DAE. We calculated the pooled diagnostic (DY) and therapeutic yields (TY), major adverse events, length of small bowel examined and sedation administered. These were also compared to younger patients.ResultsFourteen high quality articles on DAE in the elderly were included in this analysis (3289 total, 1712 elderly) patients. Nine of these studies were included in the final meta-analysis (681 elderly, 1577 young patients). The overall DY of DAE, double balloon enterosocpy (DBE) and single balloon enteroscopy (SBE) were 0.68 (p = 0.000001), 1.74 (p = 0.0001) and 1.90 (p = 0.009). The TY of DAE, DBE and SBE were 0.45 (p = 0.00001), 2.20 (p = 0.00001) and 2.36 (p = 0.00001). On comparison of elderly and young patients, DY (1.83; 95% CI: 1.49, 2.24; p = 0.00001) and TY (2.28; 95% CI: 1.79, 2.89) were better in elderly patients. There was no difference in adverse events in both groups (2.16; 95% CI: 0.82, 5.69, p = 0.12). Elderly patients were given less sedation than younger patients during DAE.ConclusionsDAE has a higher DY and TY in the elderly than younger patients. DAE can be safely carried out in the elderly with less sedation.     

Does obesity surgery improve psychosocial functioning? A systematic review

OBJECTIVE: The objective of this study is to present a review of the psychosocial outcome of bariatric surgery with special consideration of psychiatric comorbidity, psychopathology, psychosocial functioning, econometric data, and general quality of life (QoL). PURPOSE: A review of all (non-) controlled trials of the last two decades both with a retrospective and prospective design and a follow-up period of at least 1 y. RESEARCH METHODS AND PROCEDURES: The relevant literature was identified by a search of computerized databases. All articles published in English and German since 1980 were reviewed. Based on the requirements of the evidenced-based guidelines of the Agency for Health Care Policy and Research and the Scottish Intercollegiate Guidelines Network, each study was rated by a level of evidence. RESULTS: In all, 171 publications were reviewed. Using the above inclusion/exclusion criteria, 63 articles including two systematic reviews were identified. A total of 40 studies focused on psychosocial outcome after obesity surgery. CONCLUSION: Mental health and psychosocial status including social relations and employment opportunities improve for the majority of people after bariatric surgery thus leading to an improved QoL. Psychiatric comorbidity, predominantly affective disorders, and psychopathologic symptoms decrease postsurgically. A substantial percentage of bariatric surgery patients suffer from binge eating disorder or binge eating symptoms. The effect of bariatric surgery on the outcome of binge eating symptoms largely depends on the type of operation. With the exception of patients with a severe psychiatric comorbidity, the concern that obesity surgery will reinforce psychic symptoms and lead to a reduction in the QoL seems to be unfounded.     

Does prepregnancy weight change have an effect on subsequent pregnancy health outcomes? A systematic review and meta-analysis

International guidelines recommend women with an overweight or obese body mass index (BMI) aim to reduce their body weight prior to conception to minimize the risk of adverse perinatal outcomes. Recent systematic reviews have demonstrated that interpregnancy weight gain increases women's risk of developing adverse pregnancy outcomes in their subsequent pregnancy. Interpregnancy weight change studies exclude nulliparous women. This systematic review and meta-analysis was conducted following MOOSE guidelines and summarizes the evidence of the impact of preconception and interpregnancy weight change on perinatal outcomes for women regardless of parity. Sixty one studies met the inclusion criteria for this review and reported 34 different outcomes. We identified a significantly increased risk of gestational diabetes (OR 1.88, 95% CI 1.66, 2.14, I² = 87.8%), hypertensive disorders (OR 1.46 95% CI 1.12, 1.91, I² = 94.9%), preeclampsia (OR 1.92 95% CI 1.55, 2.37, I² = 93.6%), and large-for-gestational-age (OR 1.36, 95% CI 1.25, 1.49, I² = 92.2%) with preconception and interpregnancy weight gain. Interpregnancy weight loss only was significantly associated with increased risk for small-for-gestational-age (OR 1.29 95% CI 1.11, 1.50, I² = 89.9%) and preterm birth (OR 1.06 95% CI 1.00, 1.13, I² = 22.4%). Our findings illustrate the need for effective preconception and interpregnancy weight management support to improve pregnancy outcomes in subsequent pregnancies.     

What sleep behaviors are associated with bruxism in children? A systematic review and meta-analysis

Sleep and Breathing - The aim of this article was to assess the sleep behaviors that serve as risk factors related to bruxism in children ages 0 to 12&nbsp;years by performing a systematic...     

Are treatments for vasovagal syncope effective? A meta-analysis

Background

Therapies used to treat vaso-vagal syncope (VVS) recurrence have not been proven effective in single studies.

Methods

Comprehensive search of PubMed, EMBASE and Cochrane Central databases of published trials was done. Randomized or non-randomized studies, comparing the intervention of interest to control group(s), with the endpoint of spontaneous recurrence or syncope on head-up tilt test, were included. Data were extracted on an intention-to-treat basis. Study heterogeneity was analyzed by Cochran's Q statistics. A random-effect analysis was used.

Results

α-adrenergic agonists were found effective (n = 400, OR 0.19, CI 0.06–0.62, p < 0.05) in preventing VVS recurrence. β-blockers were not found to be effective when only randomized studies comparing β-blockers to non-pharmacologic agents were assessed (9 studies, n = 583, OR 0.48, CI 0.22–1.04, p = 0.06). Tilt-training had no effect when only randomized studies were considered (4 studies, n = 298, OR 0.47, CI 0.21–1.05, p = 0.07). Selective serotonin reuptake inhibitors were found effective (n = 131, OR 0.28, CI 0.10–0.74, p < 0.05), though the analysis contained only 2 studies. Pacemakers were found effective in preventing syncope recurrence when all studies were analyzed (n = 463, OR 0.13, CI 0.05–0.36, p < 0.05). However, studies comparing active pacemaker to sensing mode only did not show benefit (3 studies, n = 162, OR 0.45, CI 0.09–2.14, p = 0.32).

Conclusions

This meta-analysis highlights the totality of evidence for commonly used medications used to treat VVS, and the requirement for larger, double-blind, placebo controlled trials with longer follow-up.     

Does lipid emulsion reduce amphotericin B nephrotoxicity? A systematic review and meta-analysis

This meta-analysis of 13 studies revealed that amphotericin B delivered as a locally prepared lipid emulsion or in liposomes reduced nephrotoxicity to a similar degree, by 18.4% (relative risk [RR], 0.40 [99% confidence interval, .25-.64]; n?=?459) and 18.1% (RR, 0.48 [99% CI, .36-.64]); n?=?1233), respectively.